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PubMed2005

Comparison of motor strategies in sit-to-stand and back-to-sit motions between healthy and Alzheimer's disease elderly subjects.

We studied the kinematics of shoulder displacement during sit-to-stand and back-to-sit in 6 healthy elderly subjects and six elderly subjects with mild to moderate Alzheimer's disease in order to elucidate the impact of Alzheimer's disease on motor planning and control processes. During sit-to-stand, Alzheimer's disease subjects reduced their forward displacement and started their upward displacement earlier than healthy elderly subjects. Furthermore, shoulder path curvatures were more pronounced for upward compared with downward displacement in healthy elderly group, in contrast with Alzheimer's disease group. Temporal analysis found that: 1) for both groups, profiles of velocity of sit-to-stand and back-to-sit showed two peaks corresponding respectively to forward/upward and to downward/backward displacements, 2) peaks of velocity were almost comparable between the two groups, 3) duration of sit-to-stand was shorter than duration of back-to-sit in the two groups and 4) duration of sit-to-stand and back-to-sit was shorter in Alzheimer's disease group than in healthy elderly group. However, dissimilarities were observed for transition and deceleration phases during sit-to-stand, and for acceleration and transition phases during back-to-sit, between the two groups. Interestingly, while sit-to-stand and back-to-sit differed in healthy elderly subjects during transition and deceleration phases, such a difference was not observed for Alzheimer's disease subjects. So, our study showed that invariant spatio-temporal movement parameters in the two groups differed, while non-invariant parameters did not, and suggests that higher level motor process of whole body motions are affected by Alzheimer's disease, while lower level motor features remain intact.

Acceleration↗
PubMed2006

Abnormal proprioceptive-motor integration contributes to hypometric postural responses of subjects with Parkinson's disease.

Subjects with Parkinson's disease exhibit abnormally short compensatory steps in response to external postural perturbations. We examined whether: (1) Parkinson's disease subjects exhibit short compensatory steps due to abnormal central proprioceptive-motor integration, (2) this proprioceptive-motor deficit can be overcome by visual-motor neural circuits using visual targets, (3) the proprioceptive-motor deficit relates to the severity of Parkinson's disease, and (4) the dysfunction of central dopaminergic circuits contributes to the Parkinson's disease subjects' proprioceptive-motor deficit. Ten Parkinson's disease subjects and 10 matched control subjects performed compensatory steps in response to backward surface translations in five conditions: with eyes closed, with eyes open, to a remembered visual target, to a target without seeing their legs, and to a target while seeing their legs. Parkinson's disease subjects were separated into a moderate group and a severe group based on scores from the Unified Parkinson's Disease Rating Scale and were tested off and on their dopamine medication. Parkinson's disease subjects exhibited shorter compensatory steps than did the control subjects, but all subjects increased their step length when stepping to targets. Compared with the other subject groups, the severe Parkinson's disease subjects made larger accuracy errors when stepping to targets, and the severe Parkinson's disease subjects' step accuracy worsened the most when they were unable to see their legs. Thus, Parkinson's disease subjects exhibited short compensatory steps due to abnormal proprioceptive-motor integration and used visual input to take longer compensatory steps when a target was provided. In severe Parkinson's disease subjects, however, visual input does not fully compensate because, even with a target and unobstructed vision, they still exhibited poor step accuracy. Medication did not consistently improve the length and accuracy of the Parkinson's disease subjects' compensatory steps, suggesting that degeneration of dopamine circuits within the basal ganglia is not responsible for the proprioceptive-motor deficit that degrades compensatory steps in Parkinson's disease subjects.

Aged↗
PubMed2007

Brain regions and genes affecting postural control.

Postural control is integrated in all facets of motor commands. The role of cortico-subcortical pathways underlying postural control, including cerebellum and its afferents (climbing, mossy, and noradrenergic fibers), basal ganglia, motor thalamus, and parieto-frontal neocortex has been identified in animal models, notably through the brain lesion technique in rats and in mice with spontaneous and induced mutations. These studies are complemented by analyses of the factors underlying postural deficiencies in patients with cerebellar atrophy. With the gene deletion technique in mice, specific genes expressed in cerebellum encoding glutamate receptors (Grid2 and Grm1) and other molecules (Prkcc, Cntn6, Klf9, Syt4, and En2) have also been shown to affect postural control. In addition, transgenic mouse models of the synucleinopathies and of Huntington's disease cause deficiencies of motor coordination resembling those of patients with basal ganglia damage.

Afferent Pathways↗
PubMed2006

[Psychomotor disadaptation syndrome].

PURPOSE: We describe the psychomotor disadaptation syndrome and report the last findings on its physiopathology and therapeutic. This syndrome was first described by Pr Gaudet's team in 1986 and named "psychomotor regression syndrome". This name has been recently changed into "psychomotor disadaptation syndrome". ACTUALITIES AND STRONG POINTS: The psychomotor disadaptation syndrome is a decompensation of postural function, gait and psychomotor automatisms due to the alteration of the posture and motor programming. That alteration is linked to subcortical-frontal lesions. Clinically, the psychomotor disadaptation syndrome is characterized by postural impairments (retro-propulsion or backward disequilibrium), non-specific gait disorders, neurological signs (akinesia, reactional hypertonia, alteration of both reactive postural responses and protective reactions) and psychological troubles. Psychological troubles include fear of standing and gait in its acute feature or slowness of cognitive processing and anhedonia in its chronic feature. The psychomotor disadaptation syndrome occurs as a failure to compensate for the effects of the following three factors which entail the reduction of motor functional reserves because of their impact on frontal subcortex: 1) aging, 2) chronic illness named predisposing factors (degenerative or vascular disorders) and both 3) functional and organic acute factors. The latter factors cause a reduction of cerebral blood perfusion. The psychomotor disadaptation syndrome requires multidisciplinary management including medical, physiotherapeutic and psychological approaches. PROSPECTS AND PROJECTS: In the next years we have to determine the frequency of psychomotor disadaptation syndrome and its physiopathology needs to be further explored.

Aged↗
PubMed2004

A quantitative measure of postural sway deficits in schizophrenia.

Clinicians rely on observational methods to assess obvious signs of postural abnormalities in schizophrenia, yet subtle signs of postural deficits may go unnoticed. Posture is controlled, in large part, by the cerebellum, which has been implicated in numerous reports of structural and functional deficits in schizophrenia. Given the possibility of an underlying disruption of cerebellar function in schizophrenia, this study used an objective, quantitative measure to assess the magnitude of postural stability in this disorder. A total of 36 schizophrenia patients and 36 non-psychiatric age-matched controls stood on a pressure-sensitive platform that recorded shifts in weight (body sway) through pressure points in the feet. Patients demonstrated more postural sway than did healthy controls (p<0.01). When patients with noticeable signs of tardive dyskinesia were removed from analyses, group differences remained (p<0.01). There was no significant correlation between neuroleptic medication level and degree of postural sway (r=0.16, p=0.37). These results indicate that patients with schizophrenia have subtle, yet quantifiable, disturbances in the control of posture and balance. Quantitative measures of postural sway may provide a more sensitive means of detecting disturbances of movement than do standard clinical observations alone.

Adult↗
PubMed2006

Balance performance in adult epilepsy patients.

PURPOSE: To evaluate the magnitude of subclinical balance dysfunction in adult epilepsy patients and to assess the relative contribution of different variables to balance impairment. METHODS: Balance performance was evaluated by computerized dynamic platform posturography (CDPP) in 25 adult patients following a generalized tonic-clonic seizure (GTCS) and in 11 healthy subjects. RESULTS: The GTCS was a breakthrough seizure in 20 patients with epilepsy and a first seizure in 5. Seven of the patients had localization-related epilepsy and 13 had generalized epilepsy. Mean epilepsy duration was 6.6 years. Nineteen of the patients were treated with antiepileptic drugs (AEDs), 16 on monotherapy and three on polytherapy. Brain CT scan and EEG abnormalities were found in 7 and 14 patients, respectively. None of the patients had clinical signs of balance dysfunction. Postural function, measured by Sway Index (SI), was worse in the patients compared to controls. A lower SI was found in patients who did not receive AEDs, had one or two seizures, had a disease duration of less than a year and had a generalized epilepsy. CONCLUSIONS: Although the study group was small and heterogeneous and only a small number of parameters have reached statistical significance, it seems that posturography can be helpful in the evaluation of postural stability in adult patients with epilepsy.

Adolescent↗
PubMedDate not supplied

Comparison of thoracic kyphosis and postural stiffness in younger and older women.

BACKGROUND CONTEXT: An increase in thoracic kyphosis and postural stiffness is commonly associated with aging and many pathological conditions. Simple clinical measurements are needed to estimate the relative degree of postural stiffness to determine whether clinical interventions, such as exercise, are beneficial. PURPOSE: To compare the amount of kyphosis and postural stiffness in the thoracic spine of younger and older women. STUDY DESIGN/SETTING: Experimental design conducted at a large health science center in southeastern Texas. PATIENT SAMPLE: Fifty-one healthy adult women, 25 between the ages of 21 and 51 years and 26 aged 66 to 88 years. OUTCOME MEASURES: Index of kyphosis (IK) measured with a surveyor's flexicurve. Differences, percent change and ratios between IK measures taken in the relaxed and maximally erect positions were used to estimate postural stiffness. METHODS: Subjects were measured while standing in their usual relaxed posture and again in their maximally erect posture by three different raters. IK measures were calculated by each rater and averaged for further data analysis. Independent t tests were used to compare the two age groups at the .05 alpha level. RESULTS: Significant differences were found in both the relaxed (p= .018) and erect (p< .001) IK measures of younger and older women. The differences, percent change and ratio between the two IK measures were also significantly different in that the younger women demonstrated a greater degree of active reduction of their kyphosis (in the erect posture) than older women. CONCLUSIONS: Age-related differences in thoracic kyphosis and postural stiffness were documented between younger and older women by means of repeated flexicurve measurements performed in both a relaxed and a maximally erect position.

Adult↗
PubMed2001

[Results of videonystagmographic (VNG) analysis in vestibular post-traumatic pathology].

From February 1998 to July 1999, 569 patients affected by vestibular disorders--following a whiplash injury and/or a cranial trauma--were studied. The neuro-otological examination included a tonal audiometry, brain stem auditory evoked potentials, clinical and instrumental vestibular tests (caloric test, rotatory test, assessment of visually guided eye movements). The study of eye movements was conducted with the support of the Ulmer video-oculographical system. The aim of the research was to analyse, both from a qualitative and a quantitative perspective, the vestibular and clinical findings. Particular emphasis was laid on the incidence of the "up-beating" nystagmus in different categories of patients, all supported by a statistical study. As a result, an etiopathogenetical hypothesis of the nystagmus was advanced, based on altered otolithic and cervical inputs. At the same time, the importance of the video-nystagmographical system was stressed, to the extent that it leads to a standardised and objective analysis, fundamental for clinical and forensic aspects.

Adolescent↗
PubMed2000

Intrasession reliability of the "center of pressure minus center of mass" variable of postural control in the healthy elderly.

OBJECTIVES: To estimate the intrasession reliability of a single measure of the biomechanical variable "center of pressure minus center of mass" (COP-COM) to determine, first, how many trials must be averaged to obtain a reliable measure of postural stability, and second, the minimal metrically detectable change of the COP-COM. PARTICIPANTS: Community-living, healthy, elderly people over 60 years of age (n = 7). DESIGN: Measurements were made in double leg stance, eyes-open condition. Nine successive trials, with rests between, were carried out for each subject. DATA ANALYSIS: Intraclass correlation coefficients (ICCs). MAIN OUTCOME MEASURE: The biomechanical variable COP-COM, which represents the distance between the center of pressure and the center of mass, was measured from two force platforms and three position sensors. RESULTS: The ICCs obtained for one measure of the COP-COM were .79 in the anterior-posterior (AP) direction and .69 in mediolateral (ML) direction. With four trials, the COP-COM variable is reliable at .94 in the AP direction and .90 in the ML direction. Minimal metrically detectable changes were .10 mm (AP) and .16 mm (ML). CONCLUSION: Using four repetitions of the COP-COM variable provides a reliable measurement of postural stability.

Aged↗
PubMed2003

Quantitative assessment of the stops walking while talking test in the elderly.

OBJECTIVE: To examine whether trunk sway and walking speed differ between elderly "stoppers" and "nonstoppers" during a shorter version of the stops walking while talking (SWWT) test-an observational assessment of impaired dual-task performance-and during a normal walking trial. DESIGN: The original SWWT test was administered on the way to the test room (over a distance of 150m). Then, subjects were asked to walk 2 trials of 8m while wearing a trunk sway measuring device strapped firmly to their lower back. For the first 8-m trial, no questions were asked (control trial). During the second 8-m trial, subjects were asked an easy question (What is your age?) after walking 2m. SETTING: Long-stay geriatric care unit in Switzerland. PARTICIPANTS: Seventeen institutionalized elderly (16 women, 1 man; mean age, 86.3y; range, 79-93y). Subjects had to be able to walk at least 150m and to understand simple questions. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The amplitude of trunk sway angle and angular velocity in the forward-backward (pitch) and side-to-side (roll) directions and the duration of each trial were compared between the two 8-m walking trials with and without a question among subjects who did and did not come to a complete stop. RESULTS: In the original SWWT test, 4 persons stopped walking while talking, compared with 8 persons who stopped in the short (8-m) walking trial when a question was asked. Persons who stopped during the 8-m trial when a question was asked had significantly longer walking durations (by 19s) and larger trunk roll angular displacements (by 5.5 degrees ) during trials, both with and without a question. For both stoppers and nonstoppers, duration was longer during the trial when a question was asked. CONCLUSION: A fixed and brief walking distance, coupled with a single sudden question, provided an effective method of identifying subjects who stop walking while talking. These subjects are those who have slower walking speeds and more unstable trunk control in the roll plane even under normal walking conditions. Our findings support the predictive capabilities of a brief SWWT test for the unstable and fall-prone elderly, as well as the usefulness of objective trunk sway measures to identify gait instabilities.

Accidental Falls↗
PubMed2003

The effect of a simulated knee joint effusion on postural control in healthy subjects.

OBJECTIVE: To determine the effects of a simulated knee joint effusion on center of pressure (COP) path and mean power frequency (MPF) during standing. DESIGN: Quasi-experimental design. SETTING: Sports injury research laboratory in a university setting. PARTICIPANTS: Twenty healthy volunteers, 10 of whom (age, 20.1+/-2.4y; height, 168.0+/-8.1cm; weight, 70.4+/-13.3kg) were assigned to an effusion group and 10 of whom (age, 25+/-3.8y; height, 169.4+/-8.9cm; weight, 74.7+/-7.7kg) were assigned to a control group. INTERVENTIONS: COP data were collected before and after a 60-mL injection of sterile saline into the knee joint space. MAIN OUTCOME MEASURES: COP path and mediolateral and anteroposterior MPF. RESULTS: COP path decreased after the effusion (pre-effusion mean, 92.2+/-21.9cm; posteffusion mean, 77.27+/-23.0cm). No change was found within the control group for COP path (P>.05). No differences were detected before or after joint effusion when the MPF was examined (P>.05). CONCLUSIONS: Possible explanations for the improved postural control after the effusion include additional somatosensory feedback, an augmented neural drive to the soleus, and/or increased capsular tension.

Adult↗
PubMed2003

The relationship between sitting stability and functional performance in patients with paraplegia.

OBJECTIVES: To compare sitting stability between patients with high and low thoracic spinal cord injury (SCI), to determine the factors that can predict sitting stability, and to examine the relationship between sitting stability and functional performance. DESIGN: Cross-sectional assessment was performed on subjects with paraplegia. SETTING: Rehabilitation hospital affiliated with a medical university. PARTICIPANTS: Convenience sample of 30 adults with complete chronic thoracic SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: (1) Postural sway during quiet sitting over 30 seconds was recorded as static sitting stability, and composite maximal weight-shift during leaning tasks over 30 seconds was measured as dynamic sitting stability; (2) age, body weight, trunk length, trunk strength, postonset duration, injury level, and presence of spasticity were examined as predictive variables for sitting stability; and (3) the time for completion of upper- and lower-body dressing and undressing and transfer was measured as functional performance. RESULTS: A significant difference in composite maximal weight-shift was found between high and low thoracic SCI subjects (t=2.90, P<.01). Injury level and trunk length were 2 important predictive factors for dynamic sitting stability, and they explained 43.5% of the variance. Only the completion time of upper-body dressing and undressing correlated significantly with static (r=.465, P=.01) and dynamic (r=-.377, P<.05) sitting stability. CONCLUSIONS: The subjects with low thoracic SCI showed better dynamic sitting stability than those with high thoracic SCI. Injury level and trunk length, not trunk flexion or extension strength, predicted the outcome of dynamic sitting stability. Measures were not precise enough to predict functional performance from the viewpoint of injury level and sitting stability. The underlying premise that a reduction or increase in trunk strength is indicative of poorer or better sitting stability in SCI individuals is questioned, and implications for problem identification and treatment planning are discussed.

Activities of Daily Living↗
PubMed1995

Influence of aging on leg muscle reflex responses to stance perturbation.

The effect of age on latency and amplitude of leg muscle responses to stance perturbations was studied in 75 control subjects. They stood upright on a platform and were displaced by toe-up (upward tilt) and toe-down (downward tilt) platform rotations. Perturbations were induced during free and supported stance (holding on to a stable structure). Surface electromyograms (EMG) of the soleus (Sol) and tibialis anterior (TA) were recorded and latency and area of responses were measured. Body sway variables during stance with open or closed eyes were also recorded. Upward tilt evoked a short-latency response (SLR) in Sol and a long-latency response (LLR) in TA. Downward tilt evoked a medium-latency response (MLR) in TA and a LLR in Sol. This pattern of EMG responses was similar in both young and elderly subjects, although there were some differences in latency and amplitude. There was a significant relationship between latency of all responses and age. Slope of the regression lines of TA LLR, TA MLR, and Sol LLR was steeper than that of Sol SLR. Area of Sol SLR was unrelated to age, but a positive trend was identified in the other responses, significant for TA LLR. Under supported-stance condition, amplitude of TA MLR, TA LLR, and Sol LLR was decreased to a similar extent in both young and elderly subjects. There was a weak relationship between age and most body sway variables. A significant relationship was found between most sway variables and latency of Sol SLR and LLR, chiefly with eyes closed. Neither TA MLR nor LLR were significantly correlated with sway variables, but a trend was present for TA MLR with eyes closed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

Stimulus parameters and inertial load: effects on the incidence of protective stepping responses in healthy human subjects.

OBJECTIVE: To test the hypotheses that the incidence of protective stepping in response to sudden translations of the support would (1) increase as a function of both the magnitude of surface displacement and velocity of platform movement, and (2) decrease in association with an increase in external loading applied to the body. DESIGN: A log-linear approach was used to analyze the incidence of stepping by testing several models incorporating different platform stimulus parameters (direction, displacement, velocity) and external loading (0% and 20% body weight). SETTING: Institutional-based research laboratory. PARTICIPANTS: Eight healthy younger adult (21 to 28 years) volunteers. MAIN OUTCOME MEASURES: The incidence and number of protective steps served as the primary planned outcome variables. RESULTS: Steps occurred more frequently for anterior (83 steps) versus posterior (45 steps) translations. Step occurrence was generally proportional to platform velocity, and increased with displacements up to 15cm, but then plateaued. External loading was associated with a reduction in the number of steps for lower magnitudes of platform motion but had little effect at higher magnitudes. CONCLUSION: The tendency to step in response to externally applied disturbances to stance appears to be a complex function of direction, velocity, displacement, and inertial load.

Adult↗
PubMed1996

Ipsilateral pushing in stroke: incidence, relation to neuropsychological symptoms, and impact on rehabilitation. The Copenhagen Stroke Study.

OBJECTIVES: A "pusher syndrome" encompassing postural imbalance and hemineglect is believed to aggravate the prognosis of stroke patients. Our aim was to determine the incidence, associated neuropsychological symptoms, and the consequences for rehabilitation of ipsilateral pushing. DESIGN: Consecutive and community-based. SETTING: A stroke unit receiving all acute stroke patients from a well-defined catchment area. All stages of rehabilitation were complete within the unit. PATIENTS: 647 acute stroke patients admitted during a 1-year period. Excluded were 320 patients who did not receive physiotherapy because they did not have pareses of the leg, had a fast remission, or died. MAIN OUTCOME MEASURES: Gain in activities of daily living (ADL) function (Barthel Index), time course of functional remission, and discharge rate to nursing home. The independent impact of ipsilateral pushing was analyzed with multiple linear and logistic regression analyses. RESULTS: Ipsilateral pushing was found in 10% of the included patients. No significant differences were found in the incidence of hemineglect and anosognosia between patients with and without ipsilateral pushing. No association with side of stroke lesion was found. Ipsilateral pushing had no independent influence on gain in ADL function or discharge rate to nursing home, but patients with ipsilateral pushing used 3.6 weeks (p < .0001) more to reach the same final outcome level than did patients without ipsilateral pushing. CONCLUSIONS: The existence of a "pusher syndrome" was not confirmed. Ipsilateral pushing did not affect functional outcome, but slowed the process of recovery considerably.

Activities of Daily Living↗
PubMed1997

Exploring the basis for Tai Chi Chuan as a therapeutic exercise approach.

For many centuries Tai Chi has been a martial art form, practiced primarily in Oriental cultures. For the past 300 years this movement approach has been used as an exercise form, practiced by millions of Chinese elderly people. To date, virtually no information exists about the therapeutic elements of this intriguing movement sequence. This article provides a historical review of existing documentation of reputed Tai Chi benefits. The 108 "forms" of Tai Chi Chuan are reduced to 10 composite forms for ease of application of these forms to older individuals within a reasonable time frame. An effort is set forth to identify the potential therapeutic elements within these forms.

Age Factors↗
PubMed1998

The sit-to-stand movement in stroke patients and its correlation with falling.

OBJECTIVE: To use kinetic assessment of the sit-to-stand movement as a means of sorting out those stroke patients at risk for falling. DESIGN: A retrospective study, using a force platform to assess sit-to-stand performance and to determine its correlation with falls in stroke patients. SETTING: Hospital-based rehabilitation units. METHODS: Thirty-three stroke patients (18 fallers, 15 nonfallers) and 25 age-matched healthy subjects were included in this study. Subjects sat in an adjustable chair with their feet on two force plates and performed the standing up/sitting down movement at a self-paced, comfortable speed. RESULTS: The rate of rise in force (dF/dT) was significantly lower in stroke fallers than in stroke nonfallers and healthy subjects (23.78+/-17.38, 55.23+/-31.24, and 85.96+/-42.4 percent body weight per second, respectively [p < .005]). The center of pressure sway in mediolateral direction during rising/ sitting down was much greater in stroke fallers than in stroke nonfallers or healthy subjects (p < .05). Body weight distribution was asymmetric on the feet of stroke patients, with much more body weight on their sound side. CONCLUSIONS: The significantly lower rate of rise in force and greater postural sway while rising/sitting down may be useful in identifying stroke patients who are at risk for falling.

Accidental Falls↗